1205898673 NPI number — EAST TENNESSEE INTERNAL MEDICINE ASSOCIATES PC C/O BROOKS MORELOCK

Table of content: (NPI 1205898673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205898673 NPI number — EAST TENNESSEE INTERNAL MEDICINE ASSOCIATES PC C/O BROOKS MORELOCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST TENNESSEE INTERNAL MEDICINE ASSOCIATES PC C/O BROOKS MORELOCK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205898673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 TUSCULUM BLVD
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
GREENEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37745-4332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-787-1024
Provider Business Mailing Address Fax Number:
423-787-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 TUSCULUM BLVD
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37745-4332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-787-1024
Provider Business Practice Location Address Fax Number:
423-787-1050
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORELOCK
Authorized Official First Name:
BROOKS
Authorized Official Middle Name:
GARTH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-787-1024

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD0000030796 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5408651 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3384756 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0101 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4047882 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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